Inhalational anthrax signs/symptoms

Generally, ciprofloxacin should be continued for 2 days after the signs and symptoms of infection have disappeared, except for inhalational anthrax (postexposure). 

Inhalational anthrax Cough, chest pain, dyspnea, viral URI symptoms (sore throat, myalgias, mild fever) during prodrome Lymphadenopathy, widened mediastinum on chest radiograph, pleural effusions. Signs/symptoms progress to respiratory failure, sepsis, and hemodynamic collapse in preterminal stages. 

Signs and symptoms of inhalational anthrax follow a biphasic course. The initial phase is characterized by fever, malaise, and unproductive cough characteristic of an upper respiratory infection. Following this flu-like phase, the patient will typically recover after 2-4 days. The second phase proceeds rapidly with the following constellation of signs and symptoms acute dyspnea, pleural effusion, fever, progressively worsening respiratory failure, cyanosis, circulatory collapse, shock, and death, if left untreated. 

Table 2.5 shows how clinical signs and symptoms identified in the October 2001 cases can help clinicians distinguish other causes of ILI from inhalational anthrax. Most cases of nonanthrax ILI are associated with nasal congestion and rhinorrhea. In comparison, only one of the ten patients in the October 2001 outbreak complained of rhinorrhea. 

Symptom/sign Inhalational anthrax (n = 10) (%) Laboratory-confirmed influenza (%) ILI from other causes (%)... 

The usual incubation period is between 1 and 7 days. Cutaneous anthrax leads to formation of an itchy skin lump, then a scab within 2-6 days. Inhalational exposure can cause an initial flu-like illness followed by severe respiratory symptoms in 1-2 days, although onset may be delayed up to 60 days. Gastrointestinal anthrax leads to signs of an acute abdomen within 3-7 days, which may initially be suspected to be surgical in origin. 

---